title: Management of tricuspid regurgitation in congenital heart disease: is survival better with valve repair?
abstract: OBJECTIVE
  Tricuspid valve (TV) regurgitation in congenital heart disease includes a heterogeneous group of lesions, and few series have documented the outcomes.
  
  
  METHODS
  We reviewed the records of 553 patients with congenital heart disease who had undergone TV surgery for tricuspid regurgitation from January 1993 to December 2010. Patients with Ebstein malformation were excluded. Their mean age was 32 ± 21 years, and 300 were female (54%). The most common diagnoses were conotruncal anomaly in 216 patients (39%), previous ventricular septal defect closure in 83 (15%), atrioventricular septal defect in 77 (14%), and pulmonary atresia with an intact ventricular septum in 11 (2%). Preoperative right-sided heart failure was present in 124 patients (22%), and 55 patients (10%) had pulmonary hypertension.
  
  
  RESULTS
  TV repair was performed in 442 (80%) and TV replacement in 111 (20%) patients. Repeat sternotomy was performed in 415 patients (75%). Previous TV repair was present in 44 patients (8%); of these, 17 (38.6%) underwent repeat TV repair. The overall early mortality was 3.1% (17 patients) and was 2.5% for TV repair and 5.4% for TV replacement (P = .001). The mean follow-up period was 4.5 ± 4.1 years (maximum, 18). The overall survival at 1, 5, and 10 years was 97%, 93%, and 85%, respectively. Survival was better for patients with repair than with replacement. TV repair was an independent predictor of better survival (P = .001).
  
  
  CONCLUSIONS
  Important tricuspid regurgitation can occur with a variety of congenital diagnoses. Early mortality is low and late survival is superior with tricuspid repair than with valve replacement. Surgical treatment of tricuspid regurgitation in congenital heart disease should be performed before the onset of heart failure.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Sameh M
authors.initials: SM
authors.lastname: Said
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: dearani.joseph@mayo.edu.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn.
authors.forename: Ben
authors.initials: B
authors.lastname: Eidem
authors.affiliation: Division of Cardiac Anesthesia, Mayo Clinic, Rochester, Minn.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Stensrud
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
keywords: 20; 35; AVSD; EM; Ebstein malformation; ICD; TR; TV; VSD; atrioventricular septal defect; implantable cardiac defibrillator; tricuspid regurgitation; tricuspid valve; ventricular septal defect